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DSH450054E SCOTT AND WHITE MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
SCOTT AND WHITE MEMORIAL HOSPITAL
Subdivision Name
SCOTT AND WHITE KILLEEN OB/GYN CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450054E
Medicare Provider Number
450054
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
11/28/2007
Participating Start Date
1/1/2008
Participating Approval Date
11/28/2007
Last Recertification Date
8/29/2016
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
Baylor Scott & White Medical Center - Temple
Shahin Motakef, CEO
(254) 724-6583
Primary Contact
Scott & White Medical Center - Temple
Sara Rainey, Pharmacy Specialist
(254) 724-2081
Addresses
Street Address
3106 S. WS YOUNG
SUITE B 204
KILLEEN, TX 76543
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/26/08- DOC RECD TO CONFIRM ELIG DSH ADJ %; 4/11/08- NAME CORRECTION (WAS 'KILLEEN WEST CLINIC')
11/28/2007
April 2025
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